Permit Number Hot Work Permit Meraux Refinery Contractor

Permit Number: Hot Work Permit Meraux Refinery Contractor Name Information to be completed by Permit Holder Company: Meraux Refinery Area/Unit Permit Holder: Equipment # # Persons: Tools/Equipment to be used: Hand tools Lift trucks Double Insulated Work Order #: Scope of Proposed Task: Electric Other: Please initial that the Scope of work is clear and understood. Permit Holder: Permit issuer: Information to be completed by Permit Issuer. (Must be Chief Operator) MSDS Yes Checked N/A Previous Product in Equipment: Equipment Pre-Work LOTO Procedures Followed • Valves. Closed/Tagged/Chained/Locked • Equipment Opened/Depressurized • Blinded/Disconnected • • Electrically locked / tagged out Field Test / Attempt to Energizestart Blinds Verified & Blind-List initialed Job Hazards Req’d Done Y -- N Additional PPE Required? Equipment Pre-Work Lock Box Number: Req’d Y -- N Area Preparation Done Y -- N • Equipment Decontamination • Water Washed Y -- N • • Y -- N • N 2 Purged Y -- N Area “Wet Down” Y Y -- N • Steamed Y -- N Contained Sparks Y -- N • Other Y -- N Sumps-Drains Covered Y -- N Lighting Y -- N Clean-up oil in area Y -- N • Y -- N Additional Fire Equipment Y --Standard N Additional Standby PPE Controls 120 V w/ GFCI Job Hazards Y Signal Horn Fire Extinguisher Manual Handling / Lifting Assessment & lifting equipment Moving Parts Covers, Isolation, & Maintenance Chemical /Fuel Exposure MSDS Review, PPE Overhead Hazards Labelling, Isolation, & Barriers Vehicle Entry Procedures, Barriers, & Permit Sharp Edges Covers, PPE, & Equipment Inspections Electricity Isolation, LOTO Slips, Trips & Falls Housekeeping, & PPE Flammable Vapors / liquid Gas Testing & Isolation Static Electricity Grounding, Fumes & Dust Respirator / Eye Protection Trapped Pressure Venting, Draining, & PPE Spillage to Water Containment / Booms Working Over Water Life Jacket, & Safety Boat, Activities of Others Y -- N Standard (SSP-0011) Full Face Shield Goggles Hearing Protection Fall Protection Leather Gloves Rubber Gloves Hi-Vis Clothing, Speed Limit, & Hot Surfaces Insulation / Barriers / PPE Vehicle Traffic Signs Non Permeable Suit Specific Hazards: Additional and/or Special Instructions CATControls Testing, Labelling, & Toxic Vapors / Liquids Gas Testing & Isolation Underground Hazards Barriers Respirator ½ face Schedule, breaks, Weather Extremes Hot Liquid Procedures & PPE refreshment. . Respirator Full Face Scaffolding & Fall Protection / Spillage to Ground Secondary Containment Working at Height Harness Filter Type No Date Time Oxygen LEL 1 H 2 S CO Mechanical Lifting Benzene Other Serial # Barriers / Lift Procedures 2 Done Y Orange Vest Housekeeping, Walkways, Stairs Communications, Barriers, Permit Access & Egress Req’d Trained Fire Watch Y -- N Y --Controls N Standard Y Req’d Y Y -N Y -N Y -N Meraux Qualified Person: Calibrated? Y -N Personal H 2 S monitor Welding Apparell Supplied Air 3 4 • Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Holder, the area is prepared, and each individual has agreed to comply with the conditions of this permit. • The Permit is valid through the end of the current work shift (start and end times below) and may be extended into the next shift if necessary. Print Name Authorized All Signatures are Required PRIOR to EXTENDING permit into the following shift. Time Start Time Expires All Signatures are Required PRIOR to Hot Work Start. Signature Date Authorized Permit Holder Permit Issuer (Chief Operator) Operator Unit Operator Chief Operator Fire Watch Permit End Permit Holder Unit Work Completed Work Site in Safe Condition Yes No Yes No Print Name Signature Time Start Time Expires Signature Date Time

Permit Number will be pre-printed on form The Permit Holder completes this section of the permit prior to meeting wit permit issuer. Check if Meraux personnel doing work Check and indicate Contractor Name for contractor work Person responsible for directly supervising the work. How many Indicate work will be order numbers involved performing List tools & The Permit Holder should describe the scope of work towork be completed in this area. equipment to be used. << Indicate if the MSDS was checked for the previous product in the vessel – then make any relevant comments in this area. Indicate product last in vessel so proper PPE can be assessed. . The Permit Issuer and Permit Holder work through this section to ensure that: 1 – all Equipment Pre-Work area are checked to indicate what is REQUIRED (Req’d) 2 – to ensure that all REQUIRED Pre-Work is actually DONE The permit issuer and Permit Holder also ensure area preparation is required and Done for Bottle Watch or Low Energy Work. The Permit Issuer and Permit Holder also inspect the area for Job Hazards. In this area if a Job Hazard exists the box should be checked. Standard Controls or other appropriate measures should be taken to ensure the area is safe for work. Also – potential Environmental impacts are noted below: Identify any additional or specific Hazards of explanations of certain above information. Based on the work and hazards – specific required PPE should be Identified for the permitted work. Clarify additional controls or special instructions for the work. . A Meraux employee (or designated contractor during turnaround events) who is qualified to do air testing must test the work area prior any confined space work and must take additional samples during the course of the work. A separate form for tracking confined space entry and other required will also be required. These names, signatures and date must be complete and the Start and End time for the permit set (above) prior to work start. If, at the end of the shift, it is necessary to extend the permit, the on-coming Permit Holder and Issuer must review the area to ensure conditions have not changed and re sign the permit with start and end times. When the work is complete the Permit Holder and the Unit Operator should review the work and indicate whether it is complete and the site is in Safe condition – then print and sign their name, date and time on the form.